System, apparatus, method, and graphical user interface for screening

ABSTRACT

Disclosed is a computer-implemented method of screening a patient for end organ damage due to infection. The method entails receiving patient data relating to an identified patient in a computing system including a processor and memory coupled to the processor, wherein the memory stores programmable instructions executable by the processor. The presence of Systematic Inflammatory Response Syndrome is determined and then the presence or absence of a high probability of end organ damage due to infection. Each of the determining steps includes receiving, on a graphical user interface, one or more user selections presented on the graphical user interface and executing programmable instructions based on received user selections.

The present applications claims the benefit of U.S. ProvisionalApplication No. 62/096,754 filed on Dec. 24, 2014, and U.S. ProvisionalApplication No. 62/116,701 filed on Feb. 16, 2015. Each of thesedisclosures is hereby incorporated by reference for all purposes andmade a part of the present disclosure.

BACKGROUND

The present disclosure relates generally to a system, apparatus, method,and graphical user interface for screening, diagnosing, managing and\ortreating a patient with a medical condition. In particular, the presentdisclosure is directed to screening or diagnosing a medical condition,and even more particularly, in respect to end organ damage due toinfection. The present disclosure also relates to a computer-implementedmethod of screening a patient.

Potentially life-threatening complications can arise from an immuneresponse triggered by infection. Patients can develop a severe responseto an infection from almost any medical condition including: surgery,minor medical or dental procedures, postpartum (i.e., complications fromchildbirth), trauma, animal bites, or infections acquired inside oroutside the hospital. Chemicals released by the body to fight theinfection trigger inflammatory responses. As sepsis progresses to septicshock, blood pressure drops dramatically, which may result in damage tomultiple organ systems and even death. According to the CDC's NationalCenter for Health Statistics, the number of people seen in U.S.hospitals in 2008 increased from about 621,000 in 2008 to over 1.1million. See e.g., cdc.gov/sepsis/datareports. The number of cases hasbeen rising each year.

Treatment of sepsis currently focuses on early recognition of thecondition to minimize end-organ damage and dissemination of theinfection. The hallmarks of sepsis are easily recognized at the bedsidebut initial evidence of sepsis are frequently missed by health careproviders who are not looking for it. Also, due to the labor demands oftoday's health care enterprise, health care providers are simplyunavailable to monitor important changes in patient status. By today'sstandard of care, timely treatment depends on the ability to diagnosesepsis early and entails the following: (i) intervention in the firstthree hours, including obtaining blood cultures to detect infection inthe blood; (ii) early administration of broad-spectrum antibiotics;(iii) measurement of venous lactate as a marker of tissue hypoperfusion(a medical condition in which an organ or extremity doesn't have enoughblood); and (iv) administration of intravenous crystalloids (fluids thatcontain electrolytes). Depending on information derived from theclinical situation, treatment may further entail: (i) initiation ofcentral venous access (placement of an intravenous catheter in thepatient's neck or groin to access large bore veins); (ii) measurement ofarterial blood pressure by placement of a catheter in a patient'sartery; and (iii) initiation of vasopressor medications (medicationsthat raise blood pressure by causing very strong constriction ofarteries).

BRIEF SUMMARY

Disclosed herein are a system, method, apparatus, and graphical userinterface for screening, managing, diagnosing and\or treating a patientwith a medical condition. Also disclosed are such a system, method,apparatus, and graphical user interface for screening a patient for endorgan damage due to infection. The system, method, apparatus, andgraphical user interface are equally and more suitable for screening forsepsis, given that the associated complications and treatment are muchthe same. Disclosures described herein in relation to sepsis aretypically applicable to end organ damage due to infection (andvice-versa). The method is preferably a computer-implemented method andthe system preferably includes a handheld or locally stationed deviceconnected with one or more processor(s), a memory storing programmableinstructions, and input/output user interface.

In one aspect, a computer-implemented method of screening a patient forend organ damage due to infection is described. The method includesreceiving patient data in a computing system including a processor andmemory coupled to the processor, wherein the memory stores instructionsexecutable by the processor. Such a computing system may be composed ofa single hand-held computing device or an entire local or cloud-basednetwork, or equal, and variations thereof and in between. The presenceof Systematic Inflammatory Response Syndrome (SIRS) is determined andthen, the presence or absence of a high probability of end organ damagedue to infection is determined. Each of the determining procedure orstep is performed by receiving, on or via a graphical user interface,one or more affirmative user selections presented on the graphical userinterface. Preferably, the determining procedure or step includesexecuting instructions stored in memory, with said user selections asinput, to determine patient status relating to the presence ofSystematic Inflammatory Response Syndrome or the presence of a highprobability of end organ damage due to infection. As described herein,software may be packaged in an Application, including computer programswith algorithms for determining or screening, as described above, withuser or system supplied patient data as input.

In another aspect, a method of screening a patient for end organ damagedue to infection is described. The method entails providing patient datarelating to an identified patient into a computing system including aprocessor and memory coupled to the processor, wherein the memory storesprogrammable instructions executable by the processor, determining thepresence of Systematic Inflammatory Response Syndrome, and determiningthe presence or absence of a high probability of end organ damage due toinfection. Each of the preceding determining steps includes inputting,on a graphical user interface, one or more user selections presented onthe graphical user interface and initiating execution of programmableinstructions based on the inputted user selections.

In another aspect, a computing system is also described having at leastone processor, at least one display, and memory coupled to the at leastone processor. The memory stores programmable instructions executable bythe processor to present a plurality of graphical user interfaces on thedisplay, including a first graphical user interface and a secondgraphical user interface, and programmable instructions executable todetermine the presence of a medical condition based on user selectedpatient information received on the graphical user interfaces. The firstuser interface presents, as user selection options, patient relatedobservations or conditions (e.g., physical measurements), such thatexecuting instructions includes comparing user selected patient relatedconditions received on the user interface with a screening criteria toindicate the presence of Systematic Inflammatory Response Syndrome. Thesecond user interface presents, as user selection options, a pluralityof clinical judgment-based parameters, such that executing instructionsincludes comparing user selected clinical judgment-based parametersreceived on the user interface with a screening criteria to indicate ahigh probability of end organ damage due to infection. The programmableinstructions are further executable to generate the second userinterface upon the indication of the presence of Systematic InflammatoryResponse Syndrome. As further described herein, the user selections maybe provided or prompted on graphical user interfaces of a hand-heldcomputing device, such as tablet, and the user merely activates theprompt to make the selection. Execution of the programmable instructions(i.e., screening algorithm) may be initiated by activating a second,subsequent prompt.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete and thorough understanding of the present embodimentsand advantages thereof may be acquired by referring to the followingdescription taken in conjunction with the accompanying drawings:

FIG. 1 is a simplified block diagram illustrating a method of screeningaccording to the present disclosure;

FIGS. 1A-1E is a flowchart illustrating a preferred method of screening,according to the present disclosure;

FIG. 2A is a simplified diagram illustrating an exemplary system for orthrough which one or more steps of the method of FIGS. 1, and 1A-1E maybe performed, in accordance with an embodiment of the presentdisclosure;

FIGS. 2B and 2C are simplified schematics of an alternative exemplarysystem for or through which one or more step of the method of FIGS. 1and 1A-1E may be performed, in accordance with an embodiment of thepresent disclosure;

FIGS. 3A-3C are representative graphical user interfaces for use withthe system and method of FIG. 1, according to one embodiment of thepresent disclosure;

FIGS. 4A-4C are representative graphical user interfaces for use withthe system and method of FIGS. 1 and 1A-1E, according to one embodimentof the present disclosure;

FIGS. 5A-5D are representative graphical user interfaces for use with,or which may be generated by, the system and method of FIGS. 1 and1A-1E, according to one embodiment of the present disclosure; and

FIG. 6 is a representative graphical user interface for displaying anacuity dashboard for use with, or which may be generated by, the systemand method of FIGS. 1 and 1A-1E, according to one embodiment of thepresent disclosure.

DETAILED DESCRIPTION

Before any embodiments are explained in detail, it is to be understoodthat the systems, apparatus, methods, user interfaces, and productsaccording to the present disclosure are not limited in its applicationto the details in the examples provided in this Detailed Description.Specific examples pertaining to the management and diagnosis of apatient, potentially with end organ damage due to infection or sepsis,are provided for illustration only. The arrangement of steps in theprocess or the components in the system described in respect to apatient with end organ damage due to infection or sepsis (potentially)may be varied in further embodiments in response to differentconditions, objectives, and requirements. In such further embodiments,steps may be carried out in a manner involving different environmentalconditions, analyses thereof, and responses thereto, as well as todifferent collections of data. Moreover, the description that followsincludes exemplary apparatuses, methods, techniques, and instructionsequences that embody techniques of the disclosed subject matter. It isunderstood, however, that the described embodiments may be practicedwithout these specific details or employing only portions thereof.

As used herein, the terms “managing” or “screening” as directed to apatient or subject suspected of having a medical condition of interestmay encompass one or more of screening, diagnosing, treating, andobserving the patient or subject and collecting data therefrom.Moreover, the terms managing or screening encompasses such interactionwith a patient or subject that does not result in or confirm thepresence of the object medical condition (i.e., sepsis), as well as suchinteraction that does.

Notwithstanding the above, the present Detail Description relies on agenerally computer-implemented and\or software-implemented process ofscreening a patient for end organ damage due to infection or sepsis toillustrate relevant concepts. The described process(es) also providesthe preferred modes of carrying out the concepts in commercialapplications. The present disclosure is, of course, not limited toscreening, diagnosing, and managing for end organ damage due toinfection or sepsis, as the concepts and embodiments provides ageneralized platform for screening, diagnosing, and managing othermedical conditions. Moreover, certain aspects of the described systemsor processes, including certain graphical user interfaces and the usethereof, may be applicable to or in other patient care practices.

The simplified flowchart 100 of FIG. 1 presents, in basic terms, anexemplary method of screening for a medical condition, according to thepresent disclosure. The flowchart 1000 in FIGS. 1A-1E provides a moredetailed description of an exemplary process or method of screening fora patient for sepsis that is particularly suited for implementation by ahealth care provider-user in a hospital or other health care environmentwherein a patient is present (wherein like reference numerals are usedto indicate like elements). The method according to either FIG. 1 orFIGS. 1A-1E is preferably and, more suitably, implemented utilizing amobile or hand-held computing device storing executable programmableinstructions and communicating with an electronic network (as discussedbelow in respect to FIGS. 2A-2C). The programmable instructions areexecutable to generate and operate graphical user interfaces and to runscreening algorithms for determining and/or outputting patient status inrespect to the presence or probability of end organ damage due toinfection or sepsis (or other medical condition). Such programmableinstructions may be initiated by a health care provider-user entrustedwith the computing device and preferably, at bedside.

Referencing FIG. 1, the method is particularly suited for screening apatient for the potential for end-organ damage due to infection. In oneaspect, the method is divided into three screening process stages 120,130, 140 each of which may output one of two results (i.e., negative orpositive), thereby advancing or diverting and ceasing the screeningprocess. In another aspect, each of the three screening stages 120, 130,140 is facilitated by availability of a hand-held computing device(storing executable programmable instructions) and a graphical userinterface displayed thereon. Exemplary graphical user interfacesaccording to the disclosure are illustrated in FIGS. 3-5. Accordingly,the screening process stages 120, 130, 140 may be performed by a healthcare provider-user, at bedside, through operation of the computingdevice and the inputting of patient-related information via thegraphical user interface.

The process is commenced by identifying the patient 110, whichpreferably includes identifying and\or loading known patientinformation. Further, the patient may be registered on a system ornetwork (see e.g., FIGS. 2A-2C), and identified on an electronicdashboard (see e.g. FIG. 6 and accompanying description below). In thefirst stage 120, patient information selected or collected providesinput into an algorithm for determining the presence of SystematicInflammatory Response Syndrome. The algorithm is run by initiatingexecution of the appropriate instructions via the graphical userinterface. If a negative determination is made, the process outputs apatient status indicating the absence of Systematic InflammatoryResponse Syndrome (121). As discussed below in more detail (see FIG. 2)in respect to Systematic Inflammatory Response Syndrome, a positivepatient status is determined upon the detection and\or selection of twoof a set of criteria. Among other things, the algorithm compares theuser selections received on the graphical user interface with ascreening criteria stored in memory. Otherwise, the process outputs anegative patient status (121). Optionally, the resultant patient statusmay be registered in the associated system or network (see e.g., FIGS.2A-2C), associated with the patient in real-time, and indicated on theacuity dashboard (125).

With a positive Systematic Inflammatory Response Syndrome determination,the process advances to the second stage 130. In this stage 130, thehealth care provider, as user, provides clinical judgement-based inputto the process and to a system algorithm for determining a “high”probability of end organ damage due to infection (noting that “high” inthis context is not a relative value or degree but simply a title givenfor the positive determination). As discussed previously, the detectionor selection of any one of a set of criteria determines a positivepatient status for high probability of end organ damage due toinfection. Otherwise, the absence of such detection or selectiondetermines and outputs a False Positive patient status (131).Optionally, that resultant patient status may be registered in theassociated system or network, associated with the patient in real-time,and indicated on the acuity dashboard (125).

With a positive determination of a high probability of end organ damagedue to infection, the process advances to the third stage (130), inwhich the presence of severe or actual end organ damage due to infectionis tested. In this stage, clinical parameters are provided, through userselections, as input to the appropriate algorithm. If any one of a setof criteria is detected or selected, end organ damage due to infectionis determined. Otherwise, a negative patient status is outputted and thepresence of Systematic Inflammatory Response Syndrome is identified withthe patient (141). As before, that patient status may be registered inthe associated system or network, associated with the patient inreal-time, and indicated on the dashboard (125). In the alternative,upon the process output of the presence of end organ damage due toinfection (142), that patient status may be registered in the associatedsystem or network, associated with the patient in real-time, andindicated on the acuity dashboard (125). As a further option, theprocess may initiate one or more notification actions (150).

In one aspect, a system and method disclosed herein entails orincorporates the integration of a plurality of sources ofpatient-specific data and parameters related to the patient's medicalconditions and status to create a knowledge base of patient data. Thesedata sources may include: reports by health care providers onobservations made at bedside; electronic medical records; and data frommonitors and sensors (e.g., at the patient's bedside or at a remotelocation, or if directly attached to the patient). In another aspect orfeature, the system or method provides for intelligently presentingpatient data to the health care provider throughout an iterativeanalysis and, in which, the most current and accurate patient data ispresented.

In yet another aspect or feature, a system and a method are describedhaving the capability of identifying patients with Systemic InflammatoryResponse Syndrome (i.e., a precursor to sepsis), providing the healthcare provider the information to determine if a patient has asignificant suspicion or risk of infection or alternative explanationsfor non-infectious causes of Systematic Inflammatory Response Syndrome,and\or using the precursor information to guide the health care providerin an intelligent screening of the patient.

In one aspect, a computer implemented method of screening a patient withpossible medical condition(s) is provided wherein the Application'salgorithm(s) determine whether sufficient conditions are present to havea high likelihood of the targeted medical condition and then identifyingthat patient as having a high risk of the medical condition. The methodfurther provides recommending an intervention plan for the patientincluding recruiting and assigning health care providers as needed forexecution of the intervention plan, and iteratively analyzing patientdata and recalibrating the intervention plans as necessary.

In another aspect or feature, a system or method is described providinghardware/software platform-independent delivery and a user interfacecustomizable to the specifics of the situation including those of theuser facility and that of the patient and the patient's medicalcondition. Further, the system or method features, in certainembodiments, diagnosis or patient screening algorithms that may becustomized by integrating a human health care worker's job-specificwork-flow into the system or method for real-time screening, diagnosis,and management of a given medical condition. For example, screeningalgorithms may be customized for an advanced practice registered nursewhose work flow differs from that of a bedside registered nurse in atypical hospital environment. The system or method may further includethe capability of:

-   -   allowing supervising health-care providers to audit a patient        population for whether or not screening has been performed;    -   allowing users the option to de-selects parts of the process        algorithm to better reflect the unique requirements of a        patient, thereby decreasing false positives and increasing        positive predictive values;    -   deriving a real-time characterization of the patient census        based on the patient's acuity of illness to prioritize and        triage the patients identified with Systematic Inflammatory        Response Syndrome or suspicion of infection or other medical        conditions and to enable medical intervention based on        comparative acuity between that patient and all others present        in that facility in order to facilitate effective use of        resources and staff;    -   effectively “learning” and adapting the system or method to the        individual patient based on specifics of that patient including        that patient's pre-existing medical conditions, current status,        and evolving disease status; and    -   customizing sepsis screening or management of a given medical        condition based on that patent's individual disease condition.

The system and Application according to the disclosure also provides acustomizable, domain-specific user interface(s). The user interface isdesigned for health care providers and to lead them in an intuitivemanner through a system or method of screening, diagnosing, and managingsevere infections. The graphical user interface is further designed forefficient and effective data entry and analysis throughout screening,diagnosing, and managing of a patient. This point alone should reduce,if not eliminate, the typical initial tendency of a user toward a manualsystem or a workaround over an automated system (i.e., because of aperceived cumbersome and inflexible nature of the automated userinterface).

The systems and processes disclosed herein also has the furthercapability of being integrated with industry standard electronic medicalrecord systems, allowing health-care providers to assign patients with agiven disease state to themselves and follow the patients' progressduring the course of the shift. The system and process also allows forautomatically updating the patient's electronic medical record to placeorders for tests including but not limited to laboratory or radiographictests.

Each of FIGS. 2A-2C depicts an exemplary system in which and by whichthe process(es) of FIG. 1 may be carried out (with like referencenumerals used to indicate like elements). In one respect, the systemcomprises an input\output device, preferably a computing device, aserver, a patient information database, and\or a cloud network. In apreferred embodiment, the computing device is a handheld computingdevice with user input means and output means. For example, thecomputing device may be a smart phone, tablet, notebook, laptop, orsimilar device. The input means includes a user responsive hardwareinterface having a keyboard or touch screen, as well as the standardarray of communication ports and wireless interfaces. Preferably, theprocess description associated with FIG. 1 contemplates communicatingthrough a voice activated and\or touch screen user interface. Suitableoutput means includes a conventional display and\or communicationsinterface for connecting to a local or cloud network (includingdedicated servers).

Implementation of the method in preferred embodiments provides one ofseveral results or diagnoses. In one implementation, the method providesfor or determines the apparent absence of Systemic Inflammatory ResponseSyndrome. In another or further implementation, the method provides apositive diagnosis of, and more specifically, a high probability of endorgan damage due to severe infection. In yet another or furtherimplementation, the method provides a positive diagnosis for end organdamage due to infection. In more specific implementations describedbelow and illustrated by the flowcharts of FIGS. 1A-1E, the methodprovides a positive sepsis diagnosis, and more specifically, a highprobability of sepsis or severe sepsis. Alternatively, the method mayprovide a false positive sepsis diagnosis. The method may, in fact,calculate a false positive sepsis diagnosis, just as an experienced andexpert human health care provider may provide. It is expected, however,that implementation of the systems and methods according to the presentdisclosure will present a significantly smaller number of falsepositives than conventional systems and methods.

The flowchart 1000 of FIG. 1A-1E describes, in more detail, an exemplarymethod(s) of screening according to the present disclosure andspecifically, screening a patient for sepsis according to a preferredembodiment. The method may be characterized as being implementedsystemically or, as well, by medical personnel utilizing a hand-held orlocally stationed computing device. The computing device includes andcommunicates with a resident (on-site at a facility hosting the patient)or remotely located processor(s) and memory storing programmableinstructions executable to initiate or perform various steps in theprocess. These programmable instructions are packaged in a softwareapplication (Application) that can be initiated from or in the computingdevice. In any event, the computing device enables interactive graphicaluser interfaces to the software application responsive to input by theuser and capable of projecting output displays and other activitygenerated by the Application, as described herein.

The process includes a series of user-prompted determinations which, ifresult in a series of affirmations, outputs a sepsis diagnosis. Each ofthe determinations is made through user interaction with three menugraphical user interfaces or screens—Screen 1, Screen 2, and Screen 3.Each Screen receives inputs (directly from user or from system) and runsan algorithm to output the determination. More specifically, each screenpresents or prompts a set of user selections and the user responses orselections is received as patient data input to the algorithm. Themethod is initiated with activation of the computing device having atouch based interface (1002). Typically, the user or users will have thedevice at hand and will be physically present in a hospital or clinicenvironment attending to a patient (although such physical proximity ordirect contact is not necessarily required). Furthermore, the device maybe connected to a cloud network either wirelessly or hard wired.Preferably, the user securely logins with a password or biometricscanning to maximize security.

In a preliminary step (1004), patient information is accessed and loadedfor the patient. The patient's screening record may be accessed by:census retrieval from the server; scanning a patient wrist band; manualinput; and accessing previous patient log. In another aspect of thepresent disclosure, when the patient is assigned to a specific healthcare provider, that health care provider's total group of patients ispreferably displayed on an acuity-based electronic “dashboard.” Anacuity dashboard, such as one depicted in FIG. 6 and discussed below,provides and identifies for the health care provider, among otherthings, the screening status of patients (e.g., whether patients havebeen screened or still require screening).

In one process application, the user proceeds to take the patient'svital signs and enters the information obtained via the device interfaceas input into the software application. Typically, the vital signscollected and inputted include:

-   -   1. Blood pressure—Systolic and Diastolic    -   2. Temperature    -   3. Respiratory Rate    -   4. Peripheral capillary oxygen tension/saturation    -   5. Blood Glucose level        The application then pushes the data to the electronic medical        record securely.

In a further aspect, the application also indicates to the user whetherthe value is normal or abnormal, for example, by presenting the screenbackground in red (as opposed to normal background color) or byemploying some other alert. The Application typically provides an inputscreen by which the values collected may be entered by either turning adial or moving a slider. Alternatively, the values may be selected onthe touch interface and then manually entered. In any event, theApplication significantly improves the process of data entry byeliminating the need to transcribe vital signs from the patient'sbedside onto paper and then entering it into the computer.

In one aspect, the Application provides Screen 1 for a user-prompteddetermination based on physical measurements or measurements of thepatient (1006). The procedure may determine, in the converse, theabsence of Systematic Inflammatory Response Syndrome, thereby promptingthe user to return to the main or native screen. As shown in theflowchart, Screen 1 presents to the user as queries and\or for selectionby the user (or system), multiple possible patient condition parameters(Systematic Inflammatory Response Syndrome criteria). The user responsesare received as input and the method runs an algorithm based on theinput to determine patient status (1006). In accordance with the presentdisclosure, a user finding and menu selection of at least two of thepresented variables leads to an intermediate diagnosis. The menuselections available on Screen 1 are printed in TABLE 1 below.

TABLE 1 SCREEN 1 SELECTIONS A. Temperature greater than 100.1 less than96.8; B. Heart rate greater than 100 bpm or less than 60 bmp; C.Respiratory rate >20 breaths per minute; D. Having a new alteration ofmental status or a toxic appearance; E. Laboratory values of white bloodcell count greater than twelve thousand per ml or less than 4 thousandper ml or >10% bands; F. Blood glucose less than 60 mg/dl or more than160 mg/d; and G. None of the Above.

If the user (human health care provider) does not observe any of thepatient condition parameters as present in the patient, the user mayselect “none of the above” (as the Application input). The patient iseffectively screened and the Application updates the system's knowledgebase accordingly. The Application then displays “screening complete”complete. Upon the user hitting “OK”, the Application returns to thenative screen. Further, if the Application's algorithm does notcalculate the targeted condition being present (or the user providerselects the “none of the above” as above), the Application displays a“SYSTEMATIC INFLAMMATORY RESPONSE SYNDROME ABSENT” screen (or equal)(1006 a) before returning the user to the native screen. If theApplication calculates, using the appropriate algorithm, that sufficientmedical conditions are selected, the Systematic Inflammatory ResponseSyndrome screening criteria are met and the Application displays analert stating “Systematic Inflammatory Response Syndrome present” (1006b). In the application according to FIGS. 1A-1E, the observation orselection of two or more condition parameters by the user indicates thatthe Systematic Inflammatory Response Syndrome screening criteria aremet, thereby prompting display of the “Systematic Inflammatory ResponseSyndrome present” alert (1006 b). Upon a user-activated prompt, theApplication sends the server a label with a time stamp of “SystematicInflammatory Response Syndrome present” (for that patient), which isthen saved in the analytic server's database.

The Application now advances to Screen 2 (1010). Screen 2 enables thesystem to further adjust the sensitivity of screening based on numerouspre-test probability conditions. Each of the conditions in TABLE 2 belowis provided as user selections on Screen 2.

TABLE 2 SCREEN 2 SELECTIONS - CLINICAL JUDGEMENT A. Suspicion ofInfection (Clinical judgment); B. Recent Antibiotic administration (PastClinical Judgment); C. Recent procedure (increases probability ofinvasive infection); D. Presence of indwelling lines or catheters(increases probability of invasive infection; E. Positive blood cultures(increases probability of invasive infection); and F. None of the Above.

As shown in FIG. 1B, a “none of the above” user selection results in thesystem presenting a False Positive diagnosis. A new user selection FalsePositive Screen is then presented with the menu of selections in TABLE 3below (1010 a).

TABLE 3 FALSE POSITIVE SCREEN SELECTIONS A. OTHER; B. Benzodiazepinewithdrawal; C. Neurolept malignant syndrome (NMS); D. drug fever; E.tumor fever; F. heat stroke; G. rhabdomyolysis; H. cardiac arrhythmias;and I. pulmonary embolism.

The above menu provides possible reasons or sources for the FalsePositive diagnosis. If the user selects OTHER, the system provides apop-up screen in which the user can manually insert a reason for theFalse Positive (1010 c).

In one example, a “Subject A” is screened and results in a FalsePositive diagnosis. A reason for the False Positive, e.g., “Reason X”,is selected as discussed above and stored in the system (in the analyticserver's database). If screening of Subject A is undertaken at a latertime and arrives at Screen 1, and the same parameters as before areselected, the Application will present the query “Does the patient stillhave “Reason X”?.” This query substitutes the usual display, “SystematicInflammatory Response Syndrome Present”, and may avoid the user havingto go through Screen 2 and rendering another “FALSE POSITIVE” diagnosis.If “YES” is selected, then the Application displays the notification:“Patient previously tested False Positive for Systematic InflammatoryResponse Syndrome due to “X” and prompts the user to further selecteither “CONTINUE” or “FINISH SCREENING.” If “Continue” is selected, theprocess advances to Screen 2 as before. If “FINISH SCREENING” isselected, the results are submitted to the server and the Applicationreturns to native state.

In the alternative, if different parameters are selected on Screen 1 forSubject A, the program will display “Systematic Inflammatory ResponseSyndrome present.” On Screen 2 for “Subject A”, a clickable link ispresented indicating that the patient had a previous False PositiveSystematic Inflammatory Response Syndrome and when, activated, the“Reason X” will appear in a popup window. An “OK” button will alsoappear which, when selected, returns the process to Screen 2 for“Subject A.”

Returning to Screen 2, if one or more conditions A through E areselected, the Application will display the further diagnosis “HighProbability Sepsis Present” in a window, which the user must activate(1010 c). The user is then instructed to “Send Venous Lactate” withoptions “OK” and “Defer.” Upon user selection of “Send Venous Lactate,”the Nurse or other healthcare professional is prompted to send a bloodsample of Venous lactate from the patient. Upon selection of either “OK”or “DEFER”, the server is sent a label with a time stamped “HighProbability Sepsis Present” notice (for that patient). This informationis also saved in the log.

As shown in FIG. 1C of the process, the user advances to Screen 3 afterthe “High Probability Sepsis Present” diagnosis (1014). At Screen 3, theApplication runs an algorithm that receives user-selected clinicalparameters as input and then screens the patient for signs and symptomsof Severe Sepsis (1014). The user is presented the menu of conditionsfor selection in TABLE 4 below.

TABLE 4 SCREEN 3 USER SELECTIONS - CLINICAL PARAMETERS A. SBP <90 mmHg(<85 mmHg for Cirrhosis) B. SBP <40 mmHg from baseline C. MAP <65 mmHgD. Oxygen Saturation <92% E. Increasing Oxygen requirement F. Decreasedurine output or Creatinine >2.0 mg/dL G. New Altered Mental Status H.Platelets <100,000 I. Serum Lactic Acid Abnormal J. DIC/Petechiae orINR >2; aPTT >60 seconds K None of the Above Key: SBP—Systolic Bloodpressure MAP—Mean Arterial Pressure DIC—Dissiminated intravascularcoagulation

If the user selects Option K (“None of the Above”), the Applicationdisplays in a popup window, “Patient is Systematic Inflammatory ResponseSyndrome” and “Please Repeat Screen in 2 hours” (1014 a). With theuser's approval, the Application sends the screening results informationto the server and returns to native state. If the user opts to select“CANCEL”, the Application returns to Screen 3.

Otherwise, if the user selects of one or more of Options “B” through“J”, a diagnosis of “HIGH PROBABILITY OF SEVERE SEPSIS” is made and acorresponding display notification is provided (1014 b). The Applicationthen advances as shown in FIG. 1D and queries the user. Specifically,the user is presented a popup menu of available system notificationactivities (1018), including the following menu options:

-   -   1. SEPSIS Nurse    -   2. Pharmacy    -   3. Bed Control    -   4. Charge ICU Nurse    -   5. ICU on call MD

Upon selection of one or more of options, the system sends, via theserver, the appropriate alphanumeric page to the designated personnel(1020). The Application then presents a menu (1022) displaying thefollowing instructions:

-   -   1. Blood culture×2    -   2. Administer broad spectrum antibiotics within 60 minutes    -   3. Bolus 30 ml/kg N.S IV unless contraindicated

When the above instructions are fulfilled, the appropriate prompts onthe display may be checked, and when checked (i.e. activating “OK”), thepatient information is sent to the server. Furthermore, if the userwishes to recall the alert (after fulfilling instructions), an “ISSUERECALL” notice may be prompted to send a second page cancelling theprevious message. The Application then returns to native state.

The flowchart section (1050) of FIG. 1E represents a parallel processstemming from Screen 2 and accounting for patient conditions of EndstageLiver Disease/cirrhosis (ESLD) and Endstage Renal Disease (ESRD). Thisparallel process is initiated upon a user selection of “A” in Screen 3.The following parameters in Screens 1 and 3 are changed if the userindicates that the patient has Endstage Liver disease/cirrhosis (ESLD):

-   -   1. WBC count drops to 2×10{circumflex over ( )}3/ml;    -   2. Blood pressure parameter decreases to <85/55;    -   3. Platelet count decreases to <50,000/ml;    -   4. Dissiminated intravascular coagulation (DIC) selection is        disabled; and    -   5. International Normalized Ratio raised to 3.

The following parameters in Screen 3 are changed if the user indicatesthat the patient has endstage renal disease (ESRD):

-   -   1. Decreased urine output selection is disabled.    -   2. Creatinine is ignored in all parts of the algorithm

The following table summarizes the adjustments to the ApplicationScreens:

TABLE 5 ESLD/ESRD SCREEN OPTIONS Nuances for ESLD: (see FIG. 1E) 1.Option “A” will be decreased to <85 mmHg 2. Option “H” will be decreasedto <50,000 3. Option “J” will be disallowed Nuances for ESRD: (see FIG.1E) Option “F” will be disallowed

In one embodiment, a system 9 according to the disclosure includes acomputing device 10 as shown in FIG. 2 and as discussed above,configured for operation by one or more patient care personnel through agraphical user interface 15. Preferably, at certain stages of theprocess, the computing device 10 is operated within a patient carefacility 11 (e.g., hospital), and more specifically, proximate a subjector patient 14 identified for screening (e.g., within a patient room 12).The patient care facility 11 may include a local network including apatient database 13 provided in communication with the computing device10. The system 9 may further include a server 17 located remotely fromthe computing device 10, which may be configured with or as part of acloud network 21. In this example, a database 22 is also included andsimilarly configured, as shown in FIG. 2. The database 22 may storepatient-related or screening-related information inputted or logged asillustrated in the flowchart of FIG. 1.

Each of FIGS. 2B-2C depicts further preferred systems 200 in which andby which the process(es) of FIG. 1 may also be carried out, with likereference numerals used to indicate like elements. In FIG. 2B, thesystem 202 provides and\or incorporates a local network, while thesystem 202 of FIG. 2C provides and\or incorporates a cloud-basednetwork. The system 200 includes one or more input\output devices,preferably handheld computing device 209 a and\or stationary computingdevice 209 b, a server 205, a patient information database 201, anintegration engine 203, and a mobile device management system 207 thatmanages handheld computing devices 209 b. In a preferred embodiment, thecomputing device is a handheld computing device with user input meansand output means. For example, the computing device may be a smartphone, tablet, notebook, laptop, or similar device. The input meansincludes a user responsive hardware interface having a keyboard or touchscreen, as well as a standard array of communication ports 202 a andwireless interfaces 202 b. It is contemplated that the processesdescribed herein, including those described in respect to FIGS. 1 and 2,may communicate through a voice activated and\or touch screen userinterface. Suitable output means includes a conventional display and\orcommunications interface for connecting to a local network or cloudnetwork (including dedicated servers), as required.

Any number of commercially available mobile devices is suitable for usewith the system and processes described. These include such deviceshaving a touch-based interface, including such products referred to asipad, iphone, android tablets, and touch-based laptops. The mobiledevice is preferably connected to a wireless network for securely login.In an initial step, the patient's medical record is accessed by andthrough the device, and\or by scanning armband from camera, manualinput, census retrieval for server, previous patient history from log ondevice. If the option is unavailable, the device and the process ofinformation collection according to the present disclosure, presents theuser the option to retry or else grey out option and employ any otherthree options to access the patient's data.

FIGS. 3A-3D provide illustrative examples of graphical user interfacesthrough which or by which certain steps of the process may be performed.These user interfaces include input and output means for communicatingobject data and information as discussed above in respect to theflowchart of FIG. 1. These user interfaces are particularly applicablefor use on a handheld device such as a smartphone or digital tablet. Theuser interface 300 of FIG. 3A may correspond to the “Load PatientInformation” screen or step in FIG. 1, which is used to initiatescreening. The user interfaces 320, 330 of FIG. 3B or 3C may correspondwith or provide Screen 1 of the process. Notably, screen 330 on FIG. 3Cindicates certain patient parameters inputted for the Anonymous Patient.The system then outputs a notice to the user based on the indications inFIG. 3C. As discussed above, the presence of two Systemic InflammatoryResponse Syndrome criteria/parameters triggers a “Systemic InflammatoryResponse Syndrome Patient” notice and display.

Table 6 provides additional, exemplary graphical user interfacessuitable for use with the systems and methods described herein,including the method/process according to FIGS. 1A-1E.

TABLE 6 GRAPHICAL USER INTERFACES 1. “SCREEN 2” 410 (FIG. 4A) (with userselection options presented) 2. Output Screen 420 (FIG. 4B) (with oneuser selection inputted) 3. Output Screen 430 (FIG. 4C) (with twoaffirmative user selections prompting positive patient status - highprobability of sepsis) 4. “SCREEN 3” 510 (FIG. 5A) 5. Output Screen 520(FIG. 5B) 6. Output Screen 530 (FIG. 5C) 7. Abort/Exit Screen (FIG. 5D)

The presently described systems and processes aims to identify patientswith a high risk of end-organ damage due to severe medical conditionsand further, provide a health care provider with decision support. Thismay entail providing pre-populated vital signs or calculating shockindex to determine if the patient has SIRS, where shock index iscalculated by a standard industry practice of dividing the heart rate bythe systolic blood pressure, and also pre-populating laboratory andother pertinent clinical data. Preferably, this support eliminates theneed for the health care provider to comb through data that is notpertinent to the patient's severe medical condition. The method ofdecision support may also include explaining and documenting commonmedical factors that, previously, would have led to misdiagnosing thesevere medical condition, so as to reduce false positives and increasepositive predictive value of the computing system iteratively. Supportrecommendations are maintained in the patient's electronic medicalrecord and in the database.

For example, a patient may suffer end-organ damage (severe medicalcondition) due to infection, but the patient originally presents with anon-infectious cause for SIRS (false positive for infection) and,correctly, is not given antibiotics. Later, the patient develops SIRSthat is from an infectious cause and at this later date has a delay inadministration of antibiotics due to the health care provider not havingnoticed the appropriate markers of a new and developing condition (thatwas not present initially). To illustrate further, a patient may have afever to 101 F and has a tachycardia with a heart rate of 120, and isdiagnosed as having SIRS. The patient is considered as being free of anyclinical signs or focus of infection on laboratory or radiographicstudies, according to the experienced health care provider. The patienthas an inflammation of the pancreas (pancreatitis) that frequentlycauses fever and tachycardia. The nurse marks that the patient hasnon-infectious SIRS secondary to pancreatitis. A few days later, thepatient develops an elevated white blood cell count with elevated “bandforms” (immature white blood cells—an indicator of new or developinginfection) and has a decrease in blood pressure (resulting in a highshock index). The patient is correctly identified as having a secondSIRS state which is different from the initial state. The nurse is ableto effectively recruit assistance from a physician to order antibioticsand a pharmacist to bring those antibiotics to bedside in a time manner.

With current technology, this patient would have continued for more thaneight hours without appropriate treatment due to an anchoring heuristicresulting in an increased mortality and harm to the patient (literatureshows that mortality increases by 7% for every hour of delayedadministration of antibiotics ref: Kumar et al, 2007.) This presentsystem and process minimizes false positives and maintains thatinformation so that if the patient develops infection-related SIRS andpresents legitimate symptoms at a later time, the patient is correctlydiagnosed with infection-related SIRS.

Implementation of the presently disclosed systems and processes withconventional screening and treatment processes currently employed isexpected to achieve certain benefits, including reduction in mortalityrates, cost, and lengths of patient stay in the hospital. There is alsoan expected reduction in response time to a patient who meets criteriabased on the system's alert protocols. This prevents escalation fromsepsis to severe sepsis and/or septic shock for “at-risk” patients afterhospital admission due to delay in treatment.

There is also an expected improvement in data management by usingtemplated notes-ability to import sepsis log and post to patient'smedical record to complete the heath care provider's documentation.Furthermore, quality improvement mechanisms are made more agile by realtime data reporting, which allows for on-the-fly review of data (no needfor onerous chart review) and shorter plan-do-study-act (PDSA) cyclesfor quality improvement. This is especially important since adherence tosepsis bundles is reportable starting September 2015

There may also be numerous benefits to the health care provider. Forexample, the presently disclosed systems and processes should aid inpreventing “Algorithm Agnosia”—a condition in which the health careprovider discounts or fails to recognize a true positive event due torepeated prior false alarms. Implementation of the presently disclosedsystem and process should also aid in process normalization within thehospital by reducing variations of care, decrease telemetry utilizationby frequently screening high risk patients on non-telemetry floors, andprevent inaccurate assessments of patients on transferring from onelevel of care to another (e.g., emergency room to the floor instead ofemergency room to intensive care unit).

The following is a description of a system by which data is extractedfrom the electronic medical record and then independently processed toachieve desired output.

Examples

1. Sepsis Screening: Output data of whether patient is septic or notbased on Systemic Inflammatory Response Syndrome plus lab/radiologyinput from EMR

2. Clinical optimization of end-stage heart failure patients for assistdevice implantation or heart transplantation—data processing usesanalysis to determine what next steps the clinician must take tooptimize the patient for assist device implant (e.g., if an obesepatients who was previously excluded from transplant for morbid obesity,starves themselves and BMI drops from 30-28 between clinic visits butpre-albumin level also drop the program will indicate to the providerthat a nutrition evaluation is necessary and that the clinicallysignificant drop in BMI indicates a deterioration in health rather thanthe person getting closer to being a candidate for transplant.

3. Transfer evaluation for higher level of care: in a non-tertiary carehospital the entire hospital census is analyzed on a real-time basis andan acuity score is calculated for each patient.

Based on the acuity score, each patient will be evaluated for benefit oftransfer to a higher level of care, e.g., a patient with elevatedbilirubin, elevated AST/ALT, INR>2.0 and platelet count <100,000 willbenefit from transfer to a higher level of care for liver transplantevaluation. This data will be presented to the attending physician withthe option to refer the patient to a medical center where a hepatologistis available. If the doctor accepts the face-sheet and insurance detailsare automatically pushed to both transfer centers (accepting and sendingfacilities). The on-call consultant and hospitalists are notifiedelectronically and clinical data is presented to them. If the patient isdeemed appropriate for transfer a doctor to doctor conversation isinitiated automatically via the transfer center between all threeproviders. This system streamlines the existing workflow and ensuresthat patients who would benefit from higher level care are provided thebest care available.

The above provide some examples. It should be apparent however to oneskilled in the art that a framework is provided that allows cliniciansto build any sort of query algorithm to process data on a real-timebasis.

Sepsis is a general term used to describe a syndrome that occurs whenthe body's immune system overreacts to a local infection, resulting inuncontrolled system-wide inflammation. Undiagnosed sepsis is asignificant threat to patients' well-being, as well as a major drain onthe time, energy and resources of healthcare institutions. Severalindependent studies have shown that screening for sepsis reducesmortality rates in hospitalized patients. Use of the presently describedsystems, process, and graphical user interfaces will aid in streamliningsepsis care in acute care facilities and decreasing mortality rates,costs and length of stay. A protocol utilizing the presently disclosedsystems and processes implements a sustainable sepsis screening based onrelated algorithms for acute care hospitals. The protocol uses real-timedata import from several sources and interacts directly with teammembers and processes including: the bedside nurse, nursing assistant,pharmacy, the hospital sepsis team, bed control. As statistically basedmeasurement and standardization are often cited as the first steps toimproving quality, the present systems and processes lend themselves tosuch improvements.

In preferred embodiments, the system and process utilized tablet-basedbedside software. As it is server-linked, the tablet device providesreal-time clinical decision making support. By providing real-time datato hospitals on acuity, incidence of Systemic Inflammatory ResponseSyndrome/sepsis and severe sepsis, one can control positive predictivevalue. The systems and processes allows, therefore, for more agileprocessing and customization to individual facilities.

Sepsis screening is tailored for patients with pre-existing organ systempathology. With the presently disclosed system and processes, includingthe Application, one can modify individual variables to account forend-stage liver disease (ESLD); atrial fibrillation; heart failure;end-stage renal disease (ESRD), ventricular assist devices (LVAD andRVAD), balloon pumps and ventilators.

A suitable mobile or hand-held device for use with the presentlydisclosed systems and processes is any one of a number of commerciallyavailable mobile devices having a touch-based interface, including suchproducts referred to as ipad, iphone, android tablets, and touch-basedlaptops. The device is preferably connected to wireless network tosecurely login. In an initial step, the patient's medical record isaccessed by and through the device, and further by scanning armband fromcamera, manual input, census retrieval for server, previous patienthistory from log on device. In a typical operation, the camera input isa preferred first choice for access. If the option is unavailable, thedevice and the process of information collection according to thepresent disclosure, presents the user the option to retry or else greyout option and employ any other three options to access the patient'sdata.

FIG. 6 depicts an exemplary graphical user interface 600 embodying andillustrating one example of an acuity dashboard 610 according to thepresent disclosure. The graphical user interface 600 may be provided ona handheld computing device, other mobile device, laptop, desktop,terminal, or other computing device preferably connected and incommunication with the system(s) described herein, including those inFIGS. 2A-2C. Typically, the acuity dashboard 610 is unique to a healthcare provider-user and provides for that health care provider his\herpatient census (groups of associated patients). In the acuity dashboard600 of FIG. 6, information is conveniently provided in several columns,including a column 612 for Patient Name (i.e., patients assigned to thehealth care provider-user). The remaining columns (614, 616, 618)provide the patient's screening status for each of SystematicInflammatory Response Syndrome, Sepsis, and Severe Sepsis. The patientstatus information is, of course, preferably delivered and updated, inreal-time, by and from operation of the hand-held devices and Screens1-3 described in respect to FIG. 2, for example.

Referring to the acuity dashboard of FIG. 6, Patient 1 is shown havingbeen screened (using Screens 1 and 2) to determine the presence ofSystematic Inflammatory Response Syndrome and the presence of Sepsis.Patient 1 is also shown as (still) requiring screening (using Screen 3)for Severe Sepsis, as prompted by a positive result in the screeningsub-process using Screen 2. In contrast, patient status for Patient 3shows that the patient as being screened negative for SystematicInflammatory Response Syndrome and thus not requiring further screening.Similarly, Patient 4 is shown not requiring further screening as welldue to a scenario, for example, described below is Usage Scenario 4.

The following are exemplary Scenarios wherein an acuity dashboard andone or more processes as previously described are embodied and utilizedin an Application. The process steps may be performed by user(s) with ahandheld device or other computing device as previously discussed, andby or through a system or network as also previously discussed. Thehardware system or network and\or software application is referred to asthe Application for purposes of description.

Usage Scenario 1: New Patient Entered Into System and ApplicationCalculates a High Probability of Sepsis.

Health Care Provider starts Application on device.

Health care Provider accesses hospital census from Application and addsnew patient to their list (this patient is not yet on the list ofpreviously screened patients).

The initial acuity dashboard screen presents the following comparativeinformation for the Health Care Provider to consider, where thecomparison is being made relative to other patients on that user's listof patients while calculating probability for that individual patient:

-   -   a. Presence of high probability Systematic Inflammatory Response        Syndrome by displaying “Required Screening” under Systematic        Inflammatory Response Syndrome column    -   b. Presence of high probability of infection by evaluating        surrogate markers of infection by displaying “Required        Screening” under Sepsis column    -   c. Indicating whether or not biomarker labs are required or have        already been sent in the “Biomarker” column by indicating        “required” or “sent” or “resulted” respectively    -   d. Presence of high probability of end-organ damage due to        infection by displaying “Required Screening” under Severe Sepsis        column

The Health Care Provider then selects the patient to further evaluatethe reasons for Systematic Inflammatory Response Syndrome, presence ofinfection and presence of end organ damage due to infection byinitiating the screening process.

Application calculates based on the user's input and validation of theinformation presented via the user interface to determine the presenceof Systematic Inflammatory Response Syndrome, Infection and end organdamage due to infection.

The dashboard screen now presents to the Health Care Provider thefollowing information:

-   -   e. Presence of verified high probability of Systematic        Inflammatory Response Syndrome by displaying “Present” under        Systematic Inflammatory Response Syndrome column    -   f. Presence of infection being the cause of Systematic        Inflammatory Response Syndrome by displaying “Present” under        Sepsis column    -   g. If the lab test has been sent it will display “sent” or        “resulted” depending on if the lab test is available for review        (resulted) or is still under processing (sent). It will further        determine if the lab value is “normal” or “abnormal” and will        display the same under column “Biomarker”.    -   h. Presence of end-organ damage caused by infection by        displaying “Present” under the Severe Sepsis column

The Health Care Provider then sends alerts stating “Sepsis present” tothe other health care providers involved in the patient's care viaApplication which may interface to existing pagers, smartphones or textbased messaging devices.

Usage Scenario 2: New Patient Entered Into System and ApplicationCalculates a Low Probability of Sepsis Because the Patient Does Not HaveSepsis (True Negative).

-   -   1. Health Care Provider starts Application on device.    -   2. Health Care Provider accesses hospital census from        Application and adds new patient to their list (this patient is        not yet on the list of previously screened patients).    -   3. The initial acuity dashboard screen presents the following        comparative information for the Health Care Provider to        consider, where the comparison is being made relative to other        patients on that user's list of patients while calculating        probability for that individual patient:        -   a. Presence of low probability Systematic Inflammatory            Response Syndrome by displaying “Absent” under Systematic            Inflammatory Response Syndrome column        -   b. Absence of surrogate markers of infection by displaying            “−” under Sepsis column        -   c. Indicating that biomarker labs are not required by            displaying “−” in the “Biomarker” column        -   d. Presence of low probability of end-organ damage due to            infection by displaying “−” under Severe Sepsis column    -   4. The Health Care Provider in this case will not further screen        this patient and thereby not require allocation of time or other        resources to evaluate the patient.

Usage Scenario 3: Existing Patient Updated in System and ApplicationCalculates a High Probability of Sepsis.

-   -   1. Health Care Provider starts Application on device.    -   2. Health Care Provider reviews list of existing patients they        have previously assigned themselves    -   3. The initial acuity dashboard screen presents the following        comparative information for the Health Care Provider to        consider, where the comparison is being made relative to other        patients on that user's list of patients while calculating        probability for that individual patient who previously did not        have sepsis:        -   a. Presence of high probability Systematic Inflammatory            Response Syndrome by displaying “Required Screening” under            Systematic Inflammatory Response Syndrome column        -   b. Presence of high probability of infection by evaluating            surrogate markers of infection by displaying “Required            Screening” under Sepsis column        -   c. Indicating whether or not biomarker labs are required or            have already been sent in the “Biomarker” column by            indicating “required” or “sent” or “resulted” respectively        -   d. Presence of high probability of end-organ damage due to            infection by displaying “Required Screening” under Severe            Sepsis column    -   4. The Health Care Provider then selects the patient to further        evaluate the reasons for Systematic Inflammatory Response        Syndrome, presence of infection and presence of end organ damage        due to infection by initiating the screening process.    -   5. Application calculates based on the user's input and        validation of the information presented via the user interface        to determine the presence of Systematic Inflammatory Response        Syndrome, Infection and end organ damage due to infection.    -   6. The dashboard screen now presents to the Health Care Provider        the following information:        -   a. Presence of verified high probability of Systematic            Inflammatory Response Syndrome by displaying “Present” under            Systematic Inflammatory Response Syndrome column        -   b. Presence of infection being the cause of Systematic            Inflammatory Response Syndrome by displaying “Present” under            Sepsis column        -   c. If the lab test has been sent it will display “sent” or            “resulted” depending on if the lab test is available for            review (resulted) or is still under processing (sent). It            will further determine if the lab value is “normal” or            “abnormal” and will display the same under column            “Biomarker”.        -   d. Presence of end-organ damage caused by infection by            displaying “Present” under the Severe Sepsis column    -   7. The Health Care Provider then sends alerts stating “Sepsis        present” to the other health care providers involved in the        patient's care via Application which may interface to existing        pagers, smartphones or text based messaging devices.

Usage Scenario 4: New Patient Updated in System and ApplicationCalculates a Low Probability of Sepsis Because the Patient Has Symptomsthat Could Cause a False Positive.

-   -   1. Health Care Provider starts Application on device.    -   2. Health Care Provider accesses hospital census from        Application and adds new patient to their list (this patient is        not yet on the list of previously screened patients).    -   3. The initial acuity dashboard screen presents the following        comparative information for the Health Care Provider to        consider, where the comparison is being made relative to other        patients on that user's list of patients while calculating        probability for that individual patient:        -   a. Presence of high probability Systematic Inflammatory            Response Syndrome by displaying “Required Screening” under            Systematic Inflammatory Response Syndrome column        -   b. Absence of high probability of infection by absence            surrogate markers of infection by displaying “Required            Screening” under Sepsis column        -   c. Indicating whether or not biomarker labs are required or            have already been sent in the “Biomarker” column by            indicating “required” or “sent” or “resulted” respectively        -   d. Absence of high probability of end-organ damage due to            infection by displaying “−” under Severe Sepsis column    -   4. The Health Care Provider then selects the patient to further        evaluate the reasons for Systematic Inflammatory Response        Syndrome, presence of infection and presence of end organ damage        due to infection by initiating the screening process.    -   5. Application calculates based on the user's input and        validation of the information presented via the user interface        to determine the presence of Systematic Inflammatory Response        Syndrome, Infection and end organ damage due to infection. In        this case the user determines that there is no infection present        due to the absence of surrogate markers of infection. User        selects a reason for Systematic Inflammatory Response Syndrome        that is not related to infection.    -   6. The dashboard screen now presents to the Health Care Provider        the following information:        -   a. Presence of Non-infectious cause of Systematic            Inflammatory Response Syndrome by displaying “Non-Infectious            Systematic Inflammatory Response Syndrome” under Systematic            Inflammatory Response Syndrome column        -   b. Absence of infection being the cause of Systematic            Inflammatory Response Syndrome by displaying “Absent” under            Sepsis column        -   c. If the lab test has been sent it will display “sent” or            “resulted” depending on if the lab test is available for            review (resulted) or is still under processing (sent). It            will further determine if the lab value is “normal” or            “abnormal” and will display the same under column            “Biomarker”.        -   d. Absence of end-organ damage caused by infection by            displaying “−” under the Severe Sepsis column    -   7. The Health Care Provider by selecting the reason for        “Non-Infectious Systematic Inflammatory Response Syndrome” via        this process modifies the parameters of that discrete patient in        order that their Systematic Inflammatory Response Syndrome alert        will not trigger for the same reasons as they triggered the        initial alert. By this manner future false positives are        avoided.

Usage Scenario 5: Existing Patient Updated in System and ApplicationCalculates a Low Probability of Sepsis Because the Patient Has Symptomsthat Could Cause a False Positive.

-   -   1. Health Care Provider starts Application on device.    -   2. Health Care Provider reviews list of existing patients they        have previously assigned themselves    -   3. The initial acuity dashboard screen presents the following        comparative information for the Health Care Provider to        consider, where the comparison is being made relative to other        patients on that user's list of patients while calculating        probability for that individual patient who previously did not        have sepsis:        -   a. Presence of high probability Systematic Inflammatory            Response Syndrome by displaying “Required Screening” under            Systematic Inflammatory Response Syndrome column        -   b. Absence of high probability of infection by absence            surrogate markers of infection by displaying “Required            Screening” under Sepsis column        -   c. Indicating whether or not biomarker labs are required or            have already been sent in the “Biomarker” column by            indicating “required” or “sent” or “resulted” respectively        -   d. Absence of high probability of end-organ damage due to            infection by displaying “−” under Severe Sepsis column    -   4. The Health Care Provider then selects the patient to further        evaluate the reasons for Systematic Inflammatory Response        Syndrome, presence of infection and presence of end organ damage        due to infection by initiating the screening process.    -   5. Application calculates based on the user's input and        validation of the information presented via the user interface        to determine the presence of Systematic Inflammatory Response        Syndrome, Infection and end organ damage due to infection. In        this case the user determines that there is no infection present        due to the absence of surrogate markers of infection. They        select a reason for Systematic Inflammatory Response Syndrome        that is not related to infection.    -   6. The dashboard screen now presents to the Health Care Provider        the following information:        -   a. Presence of Non-infectious cause of Systematic            Inflammatory Response Syndrome by displaying “Non-Infectious            Systematic Inflammatory Response Syndrome” under Systematic            Inflammatory Response Syndrome column        -   b. Absence of infection being the cause of Systematic            Inflammatory Response Syndrome by displaying “Absent” under            Sepsis column        -   c. If the lab test has been sent it will display “sent” or            “resulted” depending on if the lab test is available for            review (resulted) or is still under processing (sent). It            will further determine if the lab value is “normal” or            “abnormal” and will display the same under column            “Biomarker”.        -   d. Absence of end-organ damage caused by infection by            displaying “−” under the Severe Sepsis column    -   7. The Health Care Provider by selecting the reason for        “Non-Infectious Systematic Inflammatory Response Syndrome” via        this process modifies the parameters of that discrete patient in        order that their Systematic Inflammatory Response Syndrome alert        will not trigger for the same reasons that triggered the initial        alert. By this manner future false positives are avoided.

Usage Scenario 6: Existing Patient Updated in System and ApplicationCalculates a Low Probability of Sepsis Because the Patient Does Not HaveSepsis (True Negative).

-   -   1. Health Care Provider starts Application on device.    -   2. Health care provider reviews list of existing patients they        have previously assigned themselves    -   3. The initial acuity dashboard screen presents the following        comparative information for the Health Care Provider to        consider, where the comparison is being made relative to other        patients on that user's list of patients while calculating        probability for that individual patient:        -   a. Presence of low probability Systematic Inflammatory            Response Syndrome by displaying “Absent” under Systematic            Inflammatory Response Syndrome column        -   b. Absence of surrogate markers of infection by displaying            “−” under Sepsis column        -   c. Indicating that biomarker labs are not required by            displaying “−” in the “Biomarker” column        -   d. Presence of low probability of end-organ damage due to            infection by displaying “−” under Severe Sepsis column    -   4. In this scenario, the Health Care Provider will not further        screen the patient and will not require allocation of time or        other resources for evaluating the patient

The foregoing description has been presented for purposes ofillustration and description of preferred embodiments. This descriptionis not intended to limit associated concepts to the various systems,apparatus, structures, and methods specifically described herein. Forexample, systems and methods described in the context of a patient(potentially) with sepsis, may be applicable to other medical conditionsor patients with different and further symptoms (or collections ofpatient data). As well, systems and components described in the contextof the treatment, management or diagnosis of sepsis, may be applicableand beneficial to other medical or patient-physician relationships Theembodiments described and illustrated herein are further intended toexplain the best and preferred modes for practicing the system andmethods, and to enable others skilled in the art to utilize same andother embodiments and with various modifications required by theparticular applications or uses.

What is claimed is:
 1. A computer-implemented method of screenings-multiple patients for end organ damage due to infection, said methodcomprising: receiving patient data relating to each identified patientof the multiple patients in a computing system including a processor andmemory coupled to the processor, wherein the memory stores programmableinstructions executable by the processor; determining the presence ofSystematic Inflammatory Response Syndrome in each patient; determiningthe presence or absence of a high probability of end organ damage due toinfection in each patient; generating and displaying a graphical userinterface, wherein each of said determining includes receiving, on thegraphical user interface, one or more user selections presented on thegraphical user interface and executing programmable instructions basedon received user selections; and generating an acuity dashboard anddisplaying the acuity dashboard on the graphical user interface or onanother graphical user interface, wherein the acuity dashboard presentsa patient status for each of the patients including a screening statusfor Systematic Inflammatory Response Syndrome, sepsis, severe sepsis, orcombinations thereof.
 2. The method of claim 1, wherein each of saiddetermining includes executing instructions stored in said memory, withsaid user selections as input, to output patient status indicating, inthe negative or affirmative, the presence of Systematic InflammatoryResponse Syndrome or the presence of a high probability of end organdamage due to infection.
 3. The method of claim 2, wherein saidexecuting instructions includes comparing received user selections witha stored screening criteria for indicating the presence of SystematicInflammatory Response Syndrome or the presence of a high probability ofend organ damage due to infection.
 4. The method of claim 3, whereinsaid determining the presence or absence of a high probability of endorgan damage due to infection includes executing programmableinstructions to indicate a False Positive SIRS patient status based onsaid user selections.
 5. The method of claim 4, further comprising:presenting, as user selection options on said graphical user interface,a set of sources for said False Positive SIRS; and upon receiving a userselection of one of said sources for said False Positive SIRS, recordingsaid user selection as patient data associated with said identifiedpatient.
 6. The method of claim 1, further comprising, upon determininga high probability of end organ damage due to infection as patientstatus output to said executing programmable instructions, determiningthe presence of end organ damage due to infection, including receiving,on a graphical user interface, one or more user selections and executingprogrammable instructions, with at least one of said user selections asinput, to output a patient status indicating the presence of end organdamage due to infection.
 7. The method of claim 6, wherein saiddetermining a high probability of end organ damage due to infection ispreceded by executing programmable instructions to present, as userselections options on the graphical user interface, a plurality ofclinical parameters, and wherein said executing instructions includescomparing user selections received on the graphical user interface witha stored screening criteria for identifying patient status indicatingthe presence of end organ damage due to infection.
 8. The method ofclaim 7, wherein said set of clinical parameters includes clinicalparameters in the group of clinical parameters consisting of: SystolicBlood Pressure; MAP; Oxygen Saturation; Increasing Oxygen requirement;Decreased urine output; New or Altered Mental Status; Platelets level;Serum Lactic Acid level; and DIC/Petechiae.
 9. The method of claim 7,further comprising: displaying in said acuity dashboard a group ofpatient identities and, for each patient identity, a patient screeningstatus display for indicating a patient screening status output storedfor and associated with the patient identity; and repeating saidreceiving patient data and said determining steps for a plurality ofpatient data, thereby identifying a plurality of identified patients;and wherein, after each said determining step, a patient screeningstatus output is stored in memory such that said generating saidgraphical user interface displaying a group includes displaying each ofsaid patient screening status output in a patient status display. 10.The method of claim 7, further comprising, upon identifying a patientstatus indicating the presence of end organ damage due to infection,communicating a notice via the computing system to a remote station, thecomputing system including at least one display device whereon saidgraphical user interfaces are generated and a remote station configuredto receive said notice.
 11. The method of claim 1, further comprising:providing a hand-held computing device as part of said computing system,said device having input means, output means, a processor, and a memorycoupled to the processor, wherein the memory stores program instructionsexecutable by the processor and generates an output for displayincluding: instructions executable to identify the patient; andinstructions executable to determining the presence of SystematicInflammatory Response Syndrome based on receipt of at least twopatient-identified parameters through said input means.
 12. The methodof claim 1, wherein said determining the presence or absence of a highprobability of end organ damage due to infection includes presentinguser queries, on a graphical user interface, including presenting a setof query responses as user response options, and upon receiving one ormore user selected query responses, comparing received query responseswith a screening criteria for determining the presence of a highprobability of end organ damage.
 13. The method of claim 1, furthercomprising indentifying the patient; and wherein at least some of thecollected data is retrieved from a database of historical patient data.14. The method of claim 1, wherein the generating and displaying thegraphical user interface, the receiving the one or more user selectionspresented on the graphical user interface, and the executingprogrammable instructions based on received user selections includes:generating and displaying a first graphical user interface, the firstgraphical user interface including inputs for receipt of the patientdata and an output for display of the screening status for SystematicInflammatory Response Syndrome; generating and displaying a secondgraphical user interface, the second graphical user interface includinginputs for receipt of user selections input and an output for display ofthe screening status for sepsis or severe sepsis; and generating anddisplaying a third graphical user interface, the third graphical userinterface including inputs for receipt of clinical parameters and anoutput for display of a notice indicative of the presence or absence ofsepsis or severe sepsis.
 15. The method of claim 1, further comprisingcalculating an acuity score for each of the patients based on eachpatient's acuity of illness.
 16. The method of claim 15, furthercomprising triaging the patients identified as having SystematicInflammatory Response Syndrome, sepsis, or severe sepsis based on thecalculated acuity scores.
 17. A method of screening multiple patientsfor end organ damage due to infection, said method comprising: providingpatient data relating to each identified patient of the multiplepatients into a computing system including a processor and memorycoupled to the processor, wherein the memory stores programmableinstructions executable by the processor; determining the presence ofSystematic Inflammatory Response Syndrome in each patient; anddetermining the presence or absence of a high probability of end organdamage due to infection in each patient; wherein each of saiddetermining includes inputting, on a graphical user interface, one ormore affirmative user selections presented on the graphical userinterface and initiating execution of programmable instructions based onthe inputted user selections; and generating an acuity dashboard anddisplaying the acuity dashboard on the graphical user interface or onanother graphical user interface, wherein the acuity dashboard presentsa patient status for each of the patients including a screening statusof each patient for Systematic Inflammatory Response Syndrome, sepsis,severe sepsis, or combinations thereof.
 18. The method of claim 17,wherein said graphical user interface includes user-activated promptsfor each of a set of patient-identified parameters, and wherein saiddetermining Systematic Inflammatory Response Syndrome includes, uponobserving said patient, activating at least two of said prompts toselect at least two patient-identified parameters, thereby determiningthe presence of Systematic Inflammatory Response Syndrome.
 19. Themethod of claim 17, wherein each of said determining includes initiatingexecution of instructions stored in said memory, with said userselections as input, to output patient status indicating, in thenegative or affirmative, the presence of Systematic InflammatoryResponse Syndrome or the presence of a high probability of end organdamage due to infection.
 20. The method of claim 19, wherein saidexecuting instructions includes comparing received user selections witha stored screening criteria for indicating the presence of SystematicInflammatory Response Syndrome or the presence of a high probability ofend organ damage due to infection.
 21. The method of claim 20, whereinsaid determining the presence or absence of a high probability of endorgan damage due to infection includes executing programmableinstructions to indicate a False Positive SIRS patient status based onsaid user selections.
 22. The method of claim 17, further comprising,upon determining a high probability of end organ damage due to infectionas patient status output to said executing programmable instructions,determining the presence of end organ damage due to infection, includinginputting on a graphical user interface, one or more affirmative userselections and initiating execution of executing instructions stored inmemory, with at least one of said user selections as input, to output apatient status indicating the presence of end organ damage due toinfection.
 23. The method of claim 22, wherein said determining endorgan damage due to infection is preceded by executing programmableinstructions to input, as user selection options on the graphical userinterface, a plurality of clinical parameters, and wherein saidexecuting instructions includes comparing user selections received onthe graphical user interface with a stored screening criteria foridentifying patient status indicating the presence of end organ damagedue to infection.